Initial Comments:
Based on the findings of an unannounced onsite state licensure complaint survey completed March 1, 2024, Help at Home was found not to be in compliance with the requirements of 28 Pa. Code, Health Facilities, Part IV, Chapter 611, Subpart H. Home Care Agencies and Home Care Registries.
Plan of Correction:
611.57(a) LICENSURE
Consumer Rights
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(a) The consumer of home care services provided by a home care agency or through a home care registry shall have the following rights: (1) To be involved in the service planning process and to receive services with reasonable accommodation of individual needs and preferences, except where the health and safety of the direct care worker is at risk. (2) To receive at least 10 calendar days advance written notice of the intent of the home care agency or home care registry to terminate services. Less than 10 days advance written notice may be provided in the event the consumer has failed to pay for services, despite notice, and the consumer is more than 14 days in arrears, or if the health and welfare of the direct care worker is at risk.
Observations:
Based on a review of consumer files and an interview with the agency Branch Manager, the agency failed to ensure the direct care worker assists with self administered medications (not administer medications) and failed to ensure the agreed upon hours/services were provided to the consumer, for one (1) out of three (3) consumer files (CF) reviewed (CF#1).
Findings include:
Agency 'Pennsylvania Trainings and Acknowledgement' forms were reviewed on 02/29/24 at approximately 2:30 p.m. Included in the forms was the 'Client Care' 'Medication Policy'. Section #7 states "Under no circumstances will an employee of Help at Home inject clients with medications ..... Employees must call the office immediately if they have concerns with client medications."
A review of consumer files was conducted on February 29, 2024 at approximately 11:00 a.m. Consumer start of service (SOS) is listed below.
CF#1 SOS 11/13/23: A complaint alleges the direct care worker (employee #1) administers the consumers insulin medication.
'Patient Note' dated 02/23/24 at 1:17 p.m. includes "....(CF#1) stated that on 02/09/24(employee #1) administered (CF#1s) insulin pump and instead of (employee #1) alternating sides as is required, (employee #1) administered the pump on the same side as the day before...... (CF#1 stated that (employee #1) administered the insulin pump and the needle got stuck inside of her and (employee #1) tried to take it out and it wouldn't come out....."
A Telephone interview was conducted with CF#1 on March 1, 2024 at approximately 10:30 a.m. Per CF#1, her insulin pump (consisting of a line, a cannula, and insulin) is changed every three days. CF#1 stated employee #1 changes her insulin pump.
Per documentation provided by the agency, (dated 02/28/24 at 3:30 p.m.) of internal correspondence between employee #1 and Care Coordinator, employee #1 stated to Care Coordinator that she would put the insulin pump on (CF#1), .....(CF#1) told employee #1 that she has no one else to help with her insulin ..... and employee #1 felt obligated to put the insulin pump on (CF#1).
This consumer is a waiver patient. Authorized hours from 01/01/24- 12/31/24 are 1464 hours (approximately 28 hours per week). February 2024 'Patient Calendar' was reviewed. No documentation provided of the agency fulfilling hours as agreed upon for the following dates. These dates are marked 'Missed Visit, (PCA).
02/12/24: 'Print Visit Detail ENT' 'Reason' "AR-Participant/family refused or unavailable", 'Action Taken' "Service/s cancelled by participant", 'Notes' "(...(CF#1 ) has informal care ..."
02/13/24: 'Print Visit Detail ENT' 'Reason' "AR-Participant/family refused or unavailable", 'Action Taken' "Service/s cancelled by participant", 'Notes' "(...(CF#1 ) has informal care ..."
02/14/24: 'Print Visit Detail ENT' 'Reason' "AR-Participant/family refused or unavailable", 'Action Taken' "Service/s cancelled by participant", 'Notes' "(...(CF#1 ) has informal care ..."
02/15/24: 'Print Visit Detail ENT' 'Reason' "AR-Participant/family refused or unavailable", 'Action Taken' "Service/s cancelled by participant", 'Notes' "(...(CF#1 ) has informal care ..."
02/16/24: 'Print Visit Detail ENT' 'Reason' "AR-Participant/family refused or unavailable", 'Action Taken' "Service/s cancelled by participant", 'Notes' "(...(CF#1 ) has informal care ..."
02/23/24: 'Print Visit Detail ENT' 'Reason' "AR-Participant/family refused or unavailable", 'Action Taken' "Service/s cancelled by participant", 'Notes' "(...(CF#1 ) has informal care ..."
02/24/24: 'Print Visit Detail ENT' 'Reason' "AR-Participant/family refused or unavailable", 'Action Taken' "Service/s cancelled by participant", 'Notes' "(...(CF#1 ) has informal care ..."
02/27/24: 'Print Visit Detail ENT' 'Reason' "AR-Participant/family refused or unavailable", 'Action Taken' "Service/s cancelled by participant", 'Notes' "(...(CF#1 ) has informal care ..."
02/28/24: 'Print Visit Detail ENT' 'Reason' "AR-Participant/family refused or unavailable", 'Action Taken' "Service/s cancelled by participant", 'Notes' "(...(CF#1 ) has informal care ..."
No documentation provided of a back-up plan for care in consumers plan of care/service agreement. Per the agency Care Coordinator, employee #1 was the consumers preferred direct care worker. Documentation was requested from the agency Care Coordinator of offering a different direct care worker to provide services to the consumer if employee #1 was not available. No documentation provided.
A Telephone interview was conducted with CF#1 on March 1, 2024 at approximately 10:30 a.m. Per CF#1, when employee #1 (preferred care giver) does not show up to complete her work shift, no one from the office calls her to offer a replacement caregiver. Stated the person (Friend #1) who resides with her is not her designated back-up caregiver.
An interview conducted with agency Branch Manager on February 29, 2024 at approximately 3:15 p.m. confirmed the above findings.
Plan of Correction:0800
Help at Home has removed the DCW from the case and terminated for deviating from the medication assistance policy established by the agency.
Help at Home care coordination team will conduct an onsite visit with the client and the client's representative's, to reinforce what the DCW staff is allowed and not allowed to do in regard to medication assistance. At that time an individual emergency preparedness plan and an informal support plan will be developed and documented. Once the visit is completed, the report and documentation will be reviewed by the location manager and the quality compliance lead, to ensure proper documentation before uploading to the client's profile documents.
Help at Home will conduct an audit of client files to identify any clients who may being using insulin as part of their medication regimen. DCW staff working for those clients will be contacted and reminded of the agency medication policy.
Help at Home will send a communication to all DCW staff to remind them of the agency policy on medication assistance. Communication will be sent via Help at Home's internal communication system.
Help at Home will monitor all new admissions to identify clients who may be insulin dependent to reinforce the medication assistance policy to all SCW staff assigned to those cases.
Help at home will audit 10% of client files quarterly to ensure that DCW staff are following the agencies medication assistance policies.
All communication with the DCW staff will be conducted by the location manager under the supervision of the Area Lead manager.
All audits will be conducted by the care supervision staff. Results will be reported to the location manager and the quality compliance lead for review to ensure full compliance.
611.57(c) LICENSURE
Information to be Provided
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(c) Prior to the commencement of services, the home care agency or home care registry shall provide to the consumer, the consumer's legal representative or responsible family member an information packet containing the following information in a form that is easily read and understood: (1) A listing of the available home care services that will be provided to the consumer by the direct care worker and the identity of the direct care worker who will provide the services. (2) The hours when those services will be provided. (3) Fees and total costs for those services on an hourly or weekly basis. (4) Who to contact at the Department for information about licensure requirements for a home care agency or home care registry and for compliance information about a particular home care agency or home care registry. (5) The Department's complaint Hot Line (1-800-254-5164) and the telephone number of the Ombudsman Program located with the local Area Agency on Aging (AAA). (6) The hiring and competency requirements applicable to direct care workers employed by the home care agency or referred by the home care registry. (7) A disclosure, in a format to be published by the Department in the Pennsylvania Bulletin by February 10, 2010, addressing the employee or independent contractor status of the direct care worker providing services to the consumer, and the resultant respective tax and insurance obligations and other responsibilities of the consumer and the home care agency or home care registry.
Observations:
Based on a review of consumer files, the consumer admission packet, and an interview with the agency Branch Manager, the agency failed to provide the consumer, prior to the commencement of services, the identity of the direct care worker who will provide the services and the hours when those services will be provided, for one (1) out of three (3) consumer files (CF) reviewed (CF#1).
Findings include:
A review of consumer files was conducted on February 29, 2024 at approximately 11:00 a.m. Consumer start of service (SOS) is listed below.
CF#1 SOS 11/13/23: No documentation of providing the consumer, prior to the commencement of services, the identity of the direct care worker who will provide the services and the hours when those services will be provided.
An interview conducted with agency Branch Manager on February 29, 2024 at approximately 3:15 p.m. confirmed the above findings.
Plan of Correction:0820
Help at Home will revise the adjusted service plan to include the name of any new caregiver and their status as an employee of the agency, covered by all workmen's compensation insurance.
Help at Home will conduct an audit of all new admission over the past calendar year (25% of clients) to ensure that proper notice of the DCW and their status was provided. Any files found to be deficient will be rectified by providing a new adjusted service plan that identifies the DCW and their status as an employee of Help at home, covered by all applicable insurances.
The revision of the adjusted service plan will be completed by the operations manager under the supervision of the quality compliance lead to ensure that it is compliant with 611.57 regulations.
All audits will be performed by the care supervisor staff under the direction of the location manager. All results of the audit will be reviewed by the quality compliance lead to ensure proper completion as stated.
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